Role of Three-Dimensional Printing in Treatment Planning for Orthognathic Surgery: A Systematic Review

Three-dimensional (3D) printing refers to a wide range of additive manufacturing processes that enable the construction of structures and models. It has been rapidly adopted for a variety of surgical applications, including the printing of patient-specific anatomical models, implants and prostheses, external fixators and splints, as well as surgical instrumentation and cutting guides. In comparison to traditional methods, 3D-printed models and surgical guides offer a deeper understanding of intricate maxillofacial structures and spatial relationships. This review article examines the utilization of 3D printing in orthognathic surgery, particularly in the context of treatment planning. It discusses how 3D printing has revolutionized this sector by providing enhanced visualization, precise surgical planning, reduction in operating time, and improved patient communication. Various databases, including PubMed, Google Scholar, ScienceDirect, and Medline, were searched with relevant keywords. A total of 410 articles were retrieved, of which 71 were included in this study. This article concludes that the utilization of 3D printing in the treatment planning of orthognathic surgery offers a wide range of advantages, such as increased patient satisfaction and improved functional and aesthetic outcomes.


Introduction And Background
Orthognathic surgery, also referred to as corrective jaw surgery, is a medical procedure that consists of a series of operations performed on the jaw and jawline to alter and/or enhance the facial features [1].In 1849, Simon P. Hullien performed the first mandibular osteotomy to surgically correct prognathism and classify malocclusion as class III [2].The orthodontics field has immensely evolved over time, with orthognathic surgery broadening its scope beyond malocclusion correction and facial aesthetics [3].Today, orthognathic surgeries are performed for a variety of reasons such as correcting functional issues, birth defects, traumatic injuries, facial asymmetry, orthodontic treatment, and malocclusions [3][4][5].
The success of orthognathic surgery depends on the ability to comprehend and articulate the patient's wishes, match them to the diagnosis, and formulate and execute a treatment plan accurately.Preoperative prediction and clinical examination are essential parts of orthognathic surgical planning.The surgical plan depends not only on the bone and dental diagnosis but also on the presurgical prognosis.To achieve the desired outcome, careful coordination between orthodontists and surgeons is important during all stages of treatment [6].When orthognathic surgery is performed, the surgeon must first determine the initial dentoskeletal relationship, then determine the intended final position, and finally create a threedimensional (3D) model of the movements required to achieve the goal [7,8].The primary treatment objectives are establishing orofacial function, achieving facial aesthetics, considering the patency of the airway, and making sure the results are consistent.The systemic clinical examination is subdivided into five primary examinations, namely, the profile view, the frontal view, the three-quarter view, the temporomandibular joint examination, and the occlusal evaluation [7,8].
The traditional orthognathic surgical practice consists of the collection of multiple data points, the implementation of a mock surgical procedure, and the subsequent execution of the same surgical procedure in the operating theater.It also includes cephalometric radiographs with trace elements, facial photographs, and dental impressions.The goal of each step is to create a representative model of the current relationship between the maxilla/mandible and the dental skeletal dysplasia associated with it.This relationship is then used to model surgery to evaluate the potential jaw movements and directly create surgical guide splints, which are essential for the precise intraoperative placement of the maxilla or mandible [9,10].This kind of surgery uses a traditional analytical model that takes the numbers and transfers the expected 3D movements right to the patient so they can figure out where to place the maxilla or mandible during the surgery [10].This approach, however, requires a lengthy analytical and radiographic procedure, as well as the development of dental models and splints, which takes a long time and a solid understanding of dental materials and may result in greater miscalculations during the algorithmic stage [10].
Orthognathic surgical procedures have transformed dramatically with the advent of the digital revolution.Computer-aided surgical planning allows surgeons to design the whole procedure on a computer before carrying it out.It creates a virtual representation of the patient's face and skull using cutting-edge imaging technology such as CT scanners and 3D modeling [11].Surgical navigation systems are utilized during surgery to give the surgeon real-time tracking.Infrared cameras, trackers, and computer algorithms are used to monitor the placement and movement of surgical equipment as well as the patient's anatomy.This aids in the maintenance of appropriate jaw posture and alignment and lowers the possibility of surgical mistakes [12].Intraoral scanners, cone-beam computed tomography (CBCT), and other relevant imaging technologies can be employed to provide real-time visualizations of the patient's anatomy.These illustrations assist the surgeon in calculating surgical movement accuracy and making necessary changes [13,14].
Additive manufacturing, also known as 3D printing, is the course of adding layers of material to a particular digital design to form 3D shapes and structures.It is a technique that allows the production of highprecision shapes and structures [15].The increasing demand for products with a wide variety of designs and applications paved the way for the emergence of 3D printing and the development of the fourth industrial revolution.The utilization of 3D technology has enabled considerable progress in a variety of medical treatments and surgical procedures [16][17][18].
3D printing has been attracting a lot of attention lately as a way to improve intraoperative accuracy during orthognathic procedures.It allows virtual preoperative simulation and enables the creation of personalized bone fixation and bone reconstruction materials.It also helps in creating customized surgical guides and surgical planning by physical models and templates.The use of 3D printing has also contributed to the development of surgical education and improved physician-patient relationships.This review provides an overview of the most recent developments in the utilization of 3D printing in orthodontic surgery, as well as insights into treatment planning in orthognathic surgeries.The research is done based on the question: can surgical outcomes in orthognathic surgery be significantly improved with treatment planning involving 3D printing?

Literature Search
To retrieve relevant articles, PubMed, Google Scholar, ScienceDirect, and Medline databases were searched with relevant keywords.Studies published from 2010 to 2023 were searched using various keywords such as 3D printing, three-dimensional printing, 3D printing in orthognathic surgeries, use of 3D printing in the treatment planning of orthognathic surgeries, computer-aided manufacturing in orthognathic surgeries, and clinical trials on 3D printing in orthognathic surgeries.A total of 410 articles were retrieved, of which 71 articles published from 2010 to 2023 were included in this study (Figure 1).

Eligibility Criteria
Studies with the use of 3D printing in orthognathic surgery were searched.Special attention was paid to studies that included the use of 3D printing in treatment planning during orthognathic surgery.A number of articles were excluded based on the criteria listed below in Table 1.

Results
A total of 410 articles were retrieved, of which 71 published from 2010 to 2023 were included for full-text analysis discussing the applications of 3D printing in treatment planning of orthognathic surgeries.A detailed analysis is presented below.

Is Traditional Treatment Planning Still Relevant?
Traditional surgical planning (TSP) involves a two-dimensional (2D) analysis of cephalometry, and dental casts affixed to the articulator, with a facial bow transfer of the occlusal plane of the patient.To define a treatment objective and generate a surgical plan, diagnostic data collected from clinical and radiographic preoperative evaluations and model analysis are combined.Surgeons also use manual model surgery to predict the direction and degree of displacement in the jawbone segment [19,20].The end of the 20th century has marked a rapid rise in the development and utilization of 3D technology, including computeraided design (CAD)/computer-aided manufacturing (CAM) and 3D computer-aided design systems, which has led to considerable innovation in the field of orthosurgical planning.
Although there are limitations in TSP, especially regarding treatment planning for complex dentofacial deformities, it has become the standard procedure over the years of trial and error [21].In a recent metaanalysis, Chen et al. reviewed several randomized clinical trials to investigate the effectiveness of TSP in comparison to virtual surgical planning (VSP) in orthognathic surgeries [22].The study concluded that both TSP and VSP had similar surgical accuracy when the surgeries were performed on hard tissues in a sagittal plane.In soft tissues, however, VSP showed more promising outcomes.Both VSP and TSP demonstrated a significantly greater surgical accuracy for the maxilla compared to the mandible.In specific regions such as the anterior part of the maxilla, VSP was more accurate in comparison to TSP.Patients who were treated with VSP had better symmetrical frontal view than those treated with TSP [22].
In another study, Barone et al. studied the comparative accuracy of jaw repositioning using digital and traditional surgical planning in bimaxillary orthognathic surgeries of skeletal class III patients.In their reports, digital surgical planning demonstrated a significantly better precision of jaw repositioning compared to the conventional procedure [23].Studies have shown that the incorporation of additional data can significantly enhance treatment planning precision, especially in facial asymmetry cases such as in cleft lip/palate patients.A prospective study in which 30 patients with cleft lips were enrolled for two-jaw, single-splint orthognathic surgery revealed that transferring 2D orthodontic surgery plans into a 3D setting significantly improved the treatment planning accuracy and treatment outcomes [24].
Based on the above-mentioned findings, it can be concluded that traditional 2D orthodontic surgical planning techniques remain applicable.Despite the continued popularity of traditional 2D approaches for planning orthognathic surgery, the use of 3D simulation is steadily expanding.

Overview of 3D Modeling
The process of 3D modeling involves the fabrication and reconstruction of a virtual 3D representation of a physical object or surface from imaging data [25].This technology has enabled the transformation of 2D data into 3D data [26].Traditionally, this method has been used in the manufacturing industry, but it is now used in the medical and dental fields, as well as in plastic surgery and orthodontic surgery.3D-printed models in the medical field are used for a wide range of applications, including accurate modeling of anatomy and pathology to support preoperative design and simulation of complex surgical or intervention procedures [27].In the medical field, one of the benefits of this technique is that it gives clinicians a hands-on approach that allows them to evaluate patient anatomy and plan surgeries without having to see the patient in person [28].
Patient-specific 3D models are typically created through the utilization of the patient's CT scans, MRI, Xrays, or 3D ultrasound images, which are processed and segmented to extract the intended anatomical regions and pathology from the volume images.Segmentation of the images is necessary to separate the subjects of interest and generate the 3D model [29].The multi-part 3D models are transformed into a series of surface mixtures and prepped for 3D printing by incorporating connectors and surface color data [30].Commercial software packages such as Mimics MeVislab and Analyze are widely used to process and segment images for 3D printing.Some open-source tools such as 3D Slicer and ITK-SNAP are also used to develop medical models for various clinical applications [31].
An increasing number of studies in the literature suggest that 3D printing models can be accurately replicated and developed for a wide variety of clinical applications [32][33][34].In a case study, Mathew et al. reported the clinical benefits of 3D models in surgical planning and execution.In treating mid-face deficiencies, the use of a preoperatively bent reconstruction plate resulted in improved outcomes and improved patient satisfaction [35].In another study, Narita et al. compared the length of time it took to operate on 25 patients who had a 3D model used in preoperative simulations and 20 patients who did not have a 3D model.The results demonstrated significantly different operating times between the two groups [36].Another study was conducted to evaluate the 3D printing technology in the treatment planning of complex maxillofacial procedures.According to the results, 3D models not only significantly improved the predictability but also the treatment outcomes.Using 3D models, the duration of the operation was shortened, resulting in a shorter period of general anesthesia and a shorter period of wound exposure [37].

3D Printing and Pretreatment Planning of Orthognathic Surgery
3D-printed models and surgical guides for presurgical planning: Treatment planning refers to a process in which fundamentally relevant clinical information is collected to decide the best options that are efficient, accurate, and save operation time.Pre-planning is key in several aspects, especially to reduce risks and spend less time in the surgical suite [38].The process of preoperative planning involves the careful analysis of medical images and other characteristics of patient information to gain better insights into the current problem and construct a model suitable for the patient [39].All surgical subspecialties have been employing 3D-printed models for presurgical planning.These models allow accurate planning and simulation of surgical procedures, incisions, and placement and sizing of required hardware so there is no need to perform these steps intraoperatively [40].Moreover, accurate and realistic models can be produced that provide interpretable visual guides [41].
Multiple studies have reported the efficiency of 3D printing for better preoperative planning.It is reported to considerably improve surgical outcomes by decreasing postsurgical morbidity, surgeon performance, duration of surgical procedures, less exposure to ionizing radiations, and other aspects of overall learning [42].Recent advances in computer-aided preoperative planning have revamped the analysis of surgical planning and offered a better presentation of the craniofacial complex which has enhanced the predictability of surgical outcomes [43].
3D printers have revolutionized the way we make orthopedic splints and changed the way we treat temporomandibular joint conditions.A study was conducted by Ye and colleagues in which digital splints designed using a Boolean operation were applied to various offset models modified through CAD software.The study revealed that offset dental models are more advantageous for the use of 3D-printed splints, as they are more capable of adhering to teeth [44].After reporting a lower rate of errors compared to prior studies, Shaheen et al. recommended the clinical utilization of 3D endoscopic occlusion splints [45].A few years after the initial publication of the study, a new research paper was published on 3D orthognathic splints.The study produced clinically acceptable results and was reproducible, and it was concluded that the protocol could be applied to the design and fabrication of intermediate splints for bimaxillary orthognathic surgery [45].
In planning orthognathic surgery, preoperative planning is the most critical part of the procedure.Traditional 2D technologies used in the diagnosis, planning, and fabrication of splints present limitations for orthognathic surgical planning as they cannot provide 3D information on anatomical structures.Moreover, inaccuracies may arise due to low-resolution related issues which are transferred to the design of suboptimal plaster cast [46].These shortcomings were overcome by the incorporation of 3D printing in orthognathic procedures which provides high-resolution imaging to ensure accurate skeletodental models and splints when transferring anatomical landmarks.3D printing also ensures low radiation exposure and considerable accuracy in recording the anatomy of patients via high-resolution imaging.This improves the repositioning of jaws in a computerized workflow [16].
Preoperative 3D imaging such as CT and CBCT are accurate volumetric techniques along with 100-200 µm voxels of spatial resolution which accurately deliver anatomical features of patients.These are then transferred to suitable planning platforms [16].These images are used to build various 3D-printed objects such as occlusal splints, anatomical models, patient-specific implants, and cutting guides [47].3D-printed surgical guides help in cutting bones, as well as placement of implants, and enable the surgery with maximum accuracy and minimal invasive involvement [26].3D-printed guiding splints of the jaw bones specific to the patient exactly replicate their original form and function providing an exact fit for the graft [47].3D-printed appliances such as presurgical distalizers and power are used in orthodontics which provide accurate tooth movement and customized guides for osteotomy that assist in surgical maneuvers that are as close to the 3D planning as possible [47].Unique maxillofacial and inherently unexpected traumatic injuries can be resolved by utilizing a combination of 3D technologies that are robust, beneficial, time-saving, and reduce the menial work of material molding [48][49][50].
The combined effect of digitization and 3D practices in the presurgical process has allowed digitization and 3D modeling of dental arches and skeletal anatomy before planning.From low-resolution and high-rate images obtained via CT and CBCT, a high-resolution scan of occlusal arches is integral to this process [51][52].Moreover, a composite picture of the dental-skeletal system is made possible by a CT scan of skeletal anatomy, scanned plaster models, and a reference splint with fiducial markers, via a double CBCT method, or a triple CBCT procedure has been reported [53][54][55][56].In addition, it has been suggested by several studies that the iterative closest point algorithm should be used to position the high-resolution scans of the impression-based dental arches with appropriate craniofacial contour CT scans which eliminates fiducial marking and simplifies the process [57,58].This study examined the accuracy of intraoral scan models (IRS) and cast scan models (CAST) on CBCT images utilizing 3D planning software.It determined the accuracy of registration based on scanning techniques and 3D programming software and concluded that registration through the PR function of 3D programming packages was significantly more precise than registration through the MR function [59].Intraoral scanners have greatly expanded the scope of dental recordings, allowing for high-quality orthodontic occlusal data to be recorded for composite models to be loaded onto an appropriate surgical planning platform [60,61].

Patient-Specific 3D Anatomical Models
The purpose of introducing patient-specific 3D models is to provide accurate and patient-specific anatomical details for preoperative planning.These patient-specific tools reduce the operation time and preoperative planning as well as patient safety.These patient-specific, 3D-printed, anatomic models can be employed in both in and out of operation theaters for surgical planning [38].Haptic models can be created that assist in the planning of surgical approaches by allowing cross-sectional imaging or customization of prosthetics specific to the patient's anatomy.It reduces implantation steps and anesthesia duration [62].Orthopedic, maxillofacial, and cardiothoracic surgeries are considered to be pioneers in applying 3D printing practices for customized prosthetics [38].
In a recent study, a comparison was made between the utility of preoperative planning with the use of a 3Dprinted model and a 3D-rendered image [63].The participants, who were surgical residents, were asked to create and review either a 3D computer model or a 3D-printed model and then formulate a preoperative plan.They scored higher on the surgical plan compared to non-3D-printed models.The researchers concluded that 3D printing may enhance the preoperative planning process for less experienced surgeons and may help develop surgical skills beyond the operating room [63].
3D printing is being used by doctors in orthodontics, maxilloplasty, and surgery to create flap designs before surgery to fix orbital hypertelorism and for maxillary reconstruction [64,65].Additionally, the use of 3Dprinted models in craniofacial surgical procedures has been utilized to treat Parry-Romberg syndrome and to plan for split calvarial bone grafting [66,67].

Virtual Surgical Planning
VSP is a minimally invasive surgical planning approach that utilizes digital clinical data to diagnose, select procedures, and plan treatment, including forecasting potential outcomes.Although the primary objective of VSP is to simplify clinical workflow, it can also be used for presurgical planning, reducing surgical time, and visualizing postoperative conditions [68].
Preoperative planning of orthognathic surgery includes the use of 2D radiographs as well as 2D model surgical procedures.However, studies [69,70] have shown that this approach has limitations, particularly for patients with significant facial deformities and asymmetries.2D cephalometric images do not provide full information on 3D configurations.Computer-aided surgical simulations utilizing CBCT images have revolutionized orthodontic practice and have been adapted to orthognathic surgical procedures to enable cephalometric examination, surgical simulation, and splint formation [71,72].
According to a study, computer-aided techniques allowed the precise correction of malformations of the maxilla with a yaw variation, the alignment of the proximal segment and the distal segment, and the restoration of the mandibular symmetry [73].Other studies concluded that the results of virtual orthognathic planning are aesthetically pleasing, patient satisfaction is high, the translation of the treatment plan is accurate, and the operation itself is simpler and safer [52,74].The analyzed studies were conducted using both CT and CBCT.The obvious benefits of CT versus CBCT were improved soft tissue identification and reduced image distortion in the presence of metallic elements.Image quality, the patient's supine position, and higher radiation doses were the key drawbacks [75,76].
Recent research has indicated that the cost and time associated with the planning and production of orthopedic occlusive splints through 3D virtual planning and the use of computed technologies is significantly lower than that associated with traditional treatment planning and the manual fabrication of splints [77][78][79].In another study, Tarsitano et al. investigated the cost associated with patient-specific mandibular reconstruction plates.The study involved a cohort of patients receiving treatment for mandibular neoplasms.The population was split into two cohorts of 20 patients each, with each receiving either a traditional mandibular reconstruction or a CAD-CAM mandibular reconstruction.They concluded that computational technology for mandibular reconstructive surgery will become the standard of care for reconstructive surgery, and its cost will be covered by gains in terms of surgical time improvements, quality, and lower complication rates [80].

Discussion
Corrective jaw surgery, also referred to as orthognathic surgery or orthodontic surgery, is a surgical procedure that has evolved significantly over time.It involves the relocation of the jaw to address anomalies associated with the bite, jaw alignment, facial appearance, and respiratory function [3].Using CAD/CAM in orthognathic surgery planning has allowed surgeons to use advanced imaging technologies such as CBCT to create 3D models of the patient's facial bone structure, allowing for more accurate diagnosis, treatment design, and surgical prediction [10].Intraoperative navigational systems have become increasingly popular in orthognathic surgery.These systems utilize 3D imaging and tracking technology to direct surgeons throughout the surgical process, resulting in a more accurate surgical plan, thus reducing the likelihood of errors, and improving overall surgical results [12].
The development of orthosurgical techniques, combined with the utilization of 3D printing for treatment planning, has led to an increase in the accuracy, effectiveness, and satisfaction of these procedures.As technology continues to advance, orthosurgery is expected to become increasingly sophisticated and tailored to the individual patient.In orthognathic surgery, 3D printing can be used in a variety of ways, such as replacing stone models or for the fabrication of surgical splints.Studies have identified a wide variety of advantages of 3D technologies in the treatment planning of orthognathic surgery such as drastically reducing the time required for digital planning and printing, reducing the need for multidisciplinary teams, improving the predictability of surgical outcomes, and increasing the accuracy of preoperative workups and splints [10,43,81,82].
King et al. conducted a study that revealed that the implementation of 3D technologies for oral and maxilla surgery can lead to an average reduction of 83 minutes and an expenditure of $60 per operation with the use of prefabricated surgical guides [83].VSP has the potential to improve the surgeon's understanding of the individual anatomy of the patient, as well as to provide a computer-driven workflow for jaw reshaping, thus replacing the traditional 2D methodologies used in orthodontic surgery.Furthermore, studies have demonstrated that 3D-planned treatment regimens can improve precision and improve results [84,85].
To precisely replicate virtual surgery during a real surgical procedure, it is essential to have an optimal intermaxillary relationship, occlusion, and face bow transfer.These transfers document the alignment of the maxilla with the hinge axis of the mandible rotation.For example, Ellis et al. [86] found an inaccuracy of almost 7 degrees when performing a face bow transfer.In a study conducted by Baily et al. [87], the average difference between the occlusal and Frankfort angle difference of the Hanau articulator was found to be 5 degrees, resulting in a 70% face bow transfer error.However, the preoperative simulation of 3D-printed plates and guides can reduce model surgery errors due to the lack of an articulator.Surgical guides and 3Dprinted models are becoming more and more common in the world of facial surgery, especially in the fields of mandibular reconstruction and orthodontic surgery [88].Patients also benefit from this technology as anatomical models enhance their knowledge of pathophysiology as well as the expected procedure, leading to better communication between patients and physicians and improved patient satisfaction [89][90][91].Some authors, however, do not recommend using these 3D models on a regular basis due to the higher cost and recommend using them only for complex cases [92].
Table 2 provides a summary of all the included articles.

Conclusions
The utilization of 3D printing models for oral, maxillofacial, orthognathic, and other surgeries is becoming increasingly popular due to their safety, reduced trauma, and shortened treatment times.Furthermore, 3D printing enables a more expeditious and accurate assessment of surgical, preoperative, and postoperative procedures, allowing for more efficient and accurate treatment planning.3D modeling for preoperative planning improves the 3D view of the planned operation.It enables pre-adaptation of surgical tools such as fixation plates, shortening the operation time and improving accuracy.The utilization of 3D-printed aids enables the precise re-creation of anatomical relationships and the prompt restoration of functions during orthognathic surgeries.Additionally, as these technologies do not need to be adjusted in the operating room, the implants are strong and can handle all kinds of physical activity.3D printing is becoming more and more popular, and we can expect to see several new treatments made with 3D printing in the near future.

FIGURE 1 :
FIGURE 1: Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow diagram.

TABLE 2 :
Authors/Date Database Research aim(s) Intervention/Technique Surgical outcomes/Summary Recommendations Seo et al. (2021) [3] PubMed To explore the current trends in orthognathic surgery 3D printing Improved surgical outcomes with a shorter duration of surgery Improved the accuracy of osteotomy, enabled the fabrication of intermediate and final splints, and significantly shortened preoperative surgical planning with intraoperative 2023 Alhabshi et al.Cureus 15(10): e47979.DOI 10.7759/cureus.evidence of an increased need for training and higher costs Anand et al. (2021) [12] DovePress To provide an overview of the indication of navigation in craniofacial surgeries with a focus on applied aspect, planning, and solution to the future problem Navigation Suggested remarkable improvements in surgical outcomes under the guidance of 3D planning and navigation Financial expenses and a gradual learning curve are always constraining factors in surgical navigation 2023 Alhabshi et al.Cureus 15(10): e47979.DOI 10.7759/cureus.hada tremendous impact on clinical outcomes and on the way clinicians approach treatment planning.3D printing stands out in its ability to rapidly fabricate complex structures and precise geometries The establishment of 3D PoC facilities can bring these technologies closer to the surgeon, thereby making them easier to incorporate into daily practice and improving clinical outcomes Hoang et al. printing are paving the way to produce surgical guides; however, some of the materials used may not be autoclavable and sterilizable, thus limiting their use.In addition, accuracy is often dictated by the quality of the original scan taken by intraoral scanners, which remain inaccurate when taking full arch scans or surfaces with irregularities New standards using the equipment will have to be defined to ensure that the patient's standard of care, health, will play a central role in better planning and management of the digital workflow in orthognathic surgery To present and discuss a workflow regarding Computer-aided surgical Under clinical circumstances, the accuracy of the designed Additional studies should continue to 2023 Alhabshi et al.Cureus 15(10): e47979.DOI 10.7759/cureus.3Dprinting techniques can be used to decrease the operating time The implementation of 3D 2023 Alhabshi et al.Cureus 15(10): e47979.DOI 10.7759/cureus.modelsThe educational value of 3Dprinted models in medicine cannot be overstated, as they enhance the understanding of anatomy, pathology, and disease for students, graduates, patients, and their families Clinical value is seen in personalized 3D-printed models for preoperative planning and simulating complex surgeries, leading to improved outcomes and reduced risks Hosny et al. to classic occlusal wafers for accuracy assessment CAD/CAM splints and patient-specific osteosynthesis This new technology made it easier to handle cases of skeletal asymmetry, reduced surgery duration and enabled trainee surgeons to perform the procedure accurately and Recommended for aspirants, but the cost is high 2023 Alhabshi et al.Cureus 15(10): e47979.DOI 10.7759/cureus.theseactivities is necessary for the implementation of 3D virtual imaging in daily practice Park et al.To develop the superimposition method on the lower arch by utilizing The surface superimposition method produced relatively Surface superimposition proved to be the simpler and more reliable method 2023 Alhabshi et al.Cureus 15(10): e47979.DOI 10.7759/cureus.intoCBCT scan data, as well as to investigate the impact of the registration area on the registration accuracy 3D imaging.The findings of this study suggest that the accuracy of integrating laser-scanned dental images into maxillofacial CBCT images is enhanced when a larger registration area is utilized Minor details like tooth structure may get missed, which may be necessary for models are better than 3Dreconstructed images Engel et al. (2015) [64] PubMed Surgical correction was planned using 3D printing modeling in severe orbital 3D model This approach enabled a reduction in surgical time, precise planning of osteotomy 3D models are very helpful tools in planning complex craniofacial operative 2023 Alhabshi et al.Cureus 15(10): e47979.DOI 10.7759/cureus.hasproven to be a beneficial adjunctive planning tool for determining the ideal surgical approach in individualized treatment The integration of traditional 3D models with virtual simulation has enhanced the efficiency of planning and implementation of craniomaxillofacial corrections 2023 Alhabshi et al.Cureus 15(10): e47979.DOI 10.7759/cureus.2022)[82] PubMed To identify the value proposition, creation, capture, and provision of value to users by healthcare 3D printing service providers, as well 3D printing Providers of 3D printing services and hospital surgical teams have the opportunity to collaborate and leverage their resources to enhance As hospitals are at the initial stages of incorporating 3D printing for surgical procedures, 3D printing service providers are capitalizing on their exploitative capabilities, while the surgical team is showcasing a 2023 Alhabshi et al.Cureus 15(10): e47979.DOI 10.7759/cureus.combination of 3D printing and VSP serves as a catalyst for transforming surgical planning and implementation.This is accomplished by offering tactile 3D models for visualization and planning, as well as precisely designed surgical guides for accurate execution.Professionals are required to attain the necessary skills for utilizing the software employed in the design and creation of 3Dof the Ti-mesh, exposure of the Ti-mesh in the oral cavity, and delayed infection To avoid fracture of the Ti-mesh tray, it is advisable to consider a combination repair involving a titanium reconstruction plate or the creation of a reinforced Ti-mesh tray for future cases with long-span defects, such as those in the chin area 2023 Alhabshi et al.Cureus 15(10): e47979.DOI 10.7759/cureus.Summary of findings.